Advertisement

Clinical Journal of Gastroenterology

, Volume 11, Issue 3, pp 184–187 | Cite as

Two-step progression of varenicline-induced autoimmune hepatitis

  • Mitsuru Sakakibara
  • Kazuyoshi Ohkawa
  • Takatoshi Nawa
  • Yutaro Abe
  • Akira Kusakabe
  • Toshihiro Imai
  • Kazuhiro Katayama
Case Report

Abstract

We describe a rare case of drug-induced hepatitis due to the smoking cessation agent varenicline in a 46-year-old Asian woman. The liver injury progressed in two steps. First, the liver injury started in the absence of viral/autoimmune responses, and withdrawal of varenicline lowered the increase in the levels of liver enzymes immediately. Such findings suggested varenicline-induced liver injury. Second, hepatitis recurred in association with conversion of antinuclear antibody from negative to positive about 8 weeks after the initial episode. Histology upon recurrence of liver injury revealed interface hepatitis with lymphocytic and lymphoplasmacytic portal inflammatory infiltrates extending into lobules. Such findings suggested autoimmune hepatitis. Corticosteroid treatment was effective for recurrent hepatitis. The clinical course suggests that varenicline caused drug-induced liver injury and subsequent autoimmune hepatitis. Some autoimmune changes were probably involved in the mechanism of varenicline-induced liver injury.

Keywords

Varenicline DILI AIH Drug-induced liver injury Autoimmune hepatitis 

Notes

Compliance with ethical standards

Conflict of interest

Mitsuru Sakakibara, Kazuyoshi Ohkawa, Takatoshi Nawa, Yutaro Abe, Akira Kusakabe, Toshihiro Imai and Kazuhiro Katayama declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Franck AJ, Sliter LR. Acute hepatic injury associated with varenicline in a patient with underlying liver disease. Ann Pharmacother. 2009;43:1539–43.CrossRefPubMedGoogle Scholar
  2. 2.
    Sprague D, Bambha K. Drug-induced liver injury due to varenicline: a case report. BMC Gastroenterol. 2012;12:65.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mogensen H, Björnsson ES. Varenicline-induced acute liver injury with jaundice. Hepatology. 2015;61:2110–1.CrossRefPubMedGoogle Scholar
  4. 4.
    Fontana RJ, Seeff LB, Andrade RJ, et al. Standardization of nomenclature and causality assessment in drug-induced liver injury: summary of a clinical research workshop. Hepatology. 2010;52:730–42.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Stine JG, Northup PG. Autoimmune-like drug-induced liver injury: a review and update for the clinician. Exp Opin Drug Metab Toxicol. 2016;12:1–11.CrossRefGoogle Scholar
  6. 6.
    Watanabe M, Shibuya A. Validity study of a new diagnostic scale for drug-induced liver injury in Japan-comparison with two previous scales. Hepatol Res. 2004;30:148–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Lohse AW, Hennes E. Diagnostic criteria for autoimmune hepatitis. Hepatol Res. 2007;37(Suppl 3):S509.CrossRefPubMedGoogle Scholar
  8. 8.
    Murata Y, Ogawa Y, Saibara T, et al. Tamoxifen-induced non-alcoholic steatohepatitis in patients with breast cancer: determination of a suitable biopsy site for diagnosis. Oncol Rep. 2003;10:97–100.PubMedGoogle Scholar
  9. 9.
    Ahbeddou N, Belbaraka R, Fetohi M, et al. Tamoxifen-induced hepatotoxicity. Indian J Cancer. 2011;48:385.CrossRefPubMedGoogle Scholar
  10. 10.
    Takikawa H, Takamori Y, Kumagi T, et al. Assessment of 287 Japanese cases of drug induced liver injury by the diagnostic scale of the International Consensus Meeting. Hepatol Res. 2003;27:192–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–38.CrossRefPubMedGoogle Scholar
  12. 12.
    Weiler-Normann C, Schramm C. Drug induced liver injury and its relationship to autoimmune hepatitis. J Hepatol. 2011;55:747–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Iwamura S, Kojima Y, Ohka R, et al. Nidome no kanseiken de syouyou chuusintai eshi wo mitome, yakuzai kiinsei jikomenekisei kanen to shindan sita ichirei (A case of drug-induced autoimmune hepatitis demonstrated initial findings of centrilobular necrosis at the second liver biopsy). Kouchi Sekijuuji byouin Igaku Zasshi (Med J Kouchi Redcross Hospital) [published in Japanese]. 2016;21:39–44.Google Scholar
  14. 14.
    Bebo BF, Dehghani B, Foster S, et al. Treatment with selective estrogen receptor modulators regulates myelin specific T-cells and suppresses experimental autoimmune encephalomyelitis. Glia. 2009;57:777–90.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Behfarjam F, Sanati MH, Nasseri Moghaddam S, et al. Role of Th1/Th2 cells and related cytokines in autoimmune hepatitis. Turk J Gastroenterol. 2017;28:110–4.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan

Personalised recommendations